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Why #NHSChangeDay (almost) made me late for work…

Last Wednesday I was the woman doing the comedy half-walk, half-scurry into work. I’d left on time (OK, early because I hate being late for work); I’d checked my bag (twice, because I hate not having stuff), and I was still clattering my way into work.

And it was all the fault of NHS Change Day.

It was all their fault because when I’d carefully packed my bag, I’d forgotten an essential piece of kit. Stethoscope; dictaphone; 4 black pens; NHS ID badge; NHS SmartCard… All the things that I usually take.

And I’d forgotten the stickers.

I don’t normally take stickers to work. Maybe that makes me a bad paediatrician, but it’s not something I got into the habit of doing. (I’ve never seen my seniors give out stickers either, so maybe it’s not just me)

And then I saw a pledge on the NHS Change Day pledge wall; pledging to have stickers at all times for the children we look after.

So I joined. Because it’s such a small thing to do, isn’t it? To give a child a sticker for being brave in a situation when they are ill & terrified & in a strange environment. (Actually, I sometimes think it’s worse if they don’t feel ill, because why are you going to see the doctor if you’re not poorly or having injections??)

And I’d already forgotten the stickers. So, back I went on Wednesday morning; dug out a pack of stickers; and scurried my way into work.*

And I offered each child I saw in clinic that morning a sticker, and said “thank you for coming to see me today”.

And that’s it; that’s one of my pledges for NHS Change Day done. Box ticked; self-congratulatory mode engaged; happy patients, happy parents = happy me. Except it wasn’t and isn’t that simple. Because my patients weren’t just pleased to have a sticker: they all looked surprised that I was bothering to thank them for coming, for missing school, for being asked personal questions about how difficult things could be for them. Having a Dr who recognised that coming to clinic isn’t a simple or easy thing was a surprise to them.

I like to think that I talk to my patients. It really annoys me when colleagues ignore the patient, and talk to their parents instead. It’s something that I think about quite a lot.

Giving out stickers and taking that extra moment to say “thank you” made me realise how long a way I have to go before I even come close to being good at that side of my job (sometimes, I really do not appreciate having insight. It’s incredibly annoying). So no, not a happy me.

Why bother pledging?

Some of the criticism levelled at NHS Change Day is that the pledges made are just things that we should be doing as part of our job; that if we need reminding to do this, then maybe we shouldn’t be doing this job at all.

I can see where the sceptics are coming from in some cases: maybe we should just be “doing the job”. (Maybe if I need reminding to talk to my patients, then I shouldn’t be doing this at all)

And then I’ve read the pledges.

And I’ve started to wonder what exactly “doing the job” means, because when you’re working in the NHS, then it is so easy to feel that “doing the job” is completing tasks. Fill in blood forms, take bloods, examine patient, explain management plan, supervise juniors, call the wards to make sure they’re happy, try and scurry around a quick 6am ward round to pick up any problems… For a long time, I thought that was doing my job.

Gradually, I’m realising that isn’t all. And seeing the pledges from NHS Change Day have helped me think about my practice, and what I can improve.

These aren’t pledges from people with massive resources in the most part; they’re individuals who want to make things better for the people we work for & with.

What’s amazed me about reading the pledges is how practical they are, and how wide-ranging. Bringing in treats for the night shift just makes things tick along a little easier (it’s also sanity-saving if you haven’t had a “break” all night) – that’s not in anyone’s “job description”***

Reviewing documentation & forms to make them more user-friendly: potentially time-savingfor clinicians, and safer for patients. Not one of the tasks that comes into the “job description”. (Someone is going to quibble that we should be doing audits and QI – trying to negotiate a quality improvement project past your supervisors without also having to do an audit that the department needs completing is an interesting task)

So, what is the point of NHS Change Day?

For me, it’s been a great opportunity to think about my practice and the kind of Dr that I want to be.

It’s given me so much additional support because I’ve been able to use the pledge wall as a practical tips section for improving how I work.

Most importantly, it’s been a massive catalyst for communicating ideas and enthusiasm from everyone else who’s involved. We’ve discussed ideas (I’ve lurked on some fantastic discussions). I’ve heard real experiences from people like me, who can change things in their daily lives, that make a difference.

I’ve realised that it isn’t a failure if I don’t change the entire NHS.

It isn’t a failure of NHS Change Day if we don’t solve the budget deficit; cut waiting times; keep local hospitals open…

What I can do is make things better in my way. After all, change begins with me 🙂

* I wasn’t late, by the way. I just wasn’t as early as I like to be.**

**No patients were delayed in the making of this pledge

***Job descriptions are a bit like contracts sometimes – mythical beings that are rumoured of, but rarely seen

My Pledges

“I will remember to say “Thank you” to the colleagues I work with for doing an exceptional job everyday (not just when they’ve done a superhuman one)” If this sounds like just part of my job, then you should know that I feel spectacularly uncomfortable when somebody thanks me for doing my job. I didn’t realise that other people don’t feel like this until I did a Myers-Brigg session with an amazing facilitator. Ooops

“To treat the children I work for with respect; explaining what I’m doing & why; and sharing decisions as much as is possible” No patient should feel that they need a contract like this. This blog breaks my heart. And again, I’m a paediatrics registrar, and I should be doing this anyway because that’s how paediatrics works, right? Wrong: this paper is a brilliant observation of just how children are treated, and how we all seem to accept this as normal. This is the speciality that still publishes phrases like “the terms patient, parent, and patient-parent set are used interchangeably”

“I pledge to ask my paediatric patients what I can do next time to make their visit to hospital better; and to listen to, and respect their ideas” Children are still marginalised in paediatrics – sounds silly, but it’s true. We ask parents to fill in satisfaction surveys, talk to parents about management plans, and ask parents about their worries. Parents are important, but they’re not the patient. It’s far too easy to forget that there’s a “real” child lying in that bed, with worries & fears of their own. Inspired by http://www.justbringthechocolate.com